Position Summary

This position reports directly to the assistant manager of payer analytics department.  The primary responsibility of the payer analytics team is to monitor, identify and maintain payer compliance with contractual agreements as well as assist with analysis and trends with payer denials for all facilities. The team will load and interpret insurance contracts within the Nthrive Contract Management System and utilize Nthrive Denials Manager and Analyzer to create denial dashboards. Responsible for identifying and reporting trends.  Work closely with Finance, Patient Financial Services, Payer Relations, Revenue Integrity, Utilization Review, Coding and Quality, Service-line Departments to coordinate efforts to resolve identified/quantified payment issues across the Health Care Delivery System.   

 

 

Candidates may also be expected to assist in performing other administrative tasks as assigned as well as assisting other areas of the Revenue Cycle Division or Clinical Services Division as deemed necessary.

Primary Responsibilities & Requirements

Performs wide range of analytical functions for contract management and denial management; including financial performance, reimbursement comparisons, risk analysis, payment variance and denial trends. Creates and communicates complex financial and risk models on future and existing contracts. Manages payer contract database; acts as administrator. Contact for denial staff, patient accounts, and other departments as a resource to provide appropriate guidance to facilitate denial management and trends.  Including payer relation communication, denial trends, and payer updates. Interacts with key stakeholders in the organization regarding managed care trends/reports/models/denials. Completes dashboards as requested. Performs revenue cycle analysis/trends of key payers. Assists with reporting/dashboards for value based contracts and bundled payment initiatives. Participate in joint committee meetings to discuss payer trends/contract status Participate in unit, department or hospital wide quality improvement efforts on ongoing basis Respond to all requests for information or analysis Perform ad hoc analysis to support strategy, growth and initiatives as requested Participate in committees and task forces as assigned Maintains excellent customer service techniques and relations at all times Complete all required education

Desired Job Qualifications/Skill Sets

Effective Communicator Excellent Data Analysis abilities Detailed knowledge of Healthcare insurance and payment guidelines Ability to manage multiple assignments, well organized Detailed understanding of Facility and Professional billing & payment methodologies Prior management experience involving directing a multi-functional team Solid writing and computer skills, including Healthcare Specific software